Provider Demographics
NPI:1851365340
Name:MAURER, BRADLEY W
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:W
Last Name:MAURER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6955 HATCHES CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-8646
Mailing Address - Country:US
Mailing Address - Phone:440-594-3540
Mailing Address - Fax:
Practice Address - Street 1:6955 HATCHES CORNERS RD
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-8646
Practice Address - Country:US
Practice Address - Phone:440-594-3540
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2248213Medicaid